Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
96 Cards in this Set
- Front
- Back
|
Symptoms of Schizophrenia reflect a disorder of what CNS pathway?
|
The Limbic system.
|
|
|
Describe some of the cognitive and affective symptoms associated with Shizophrenia.
|
Cognitive symptoms include hallucinations, thought disorder, and delusions. Affective symptoms include paranoia, apathy, and withdrawal
|
|
|
What is thought to be the root cause of Schizophrenia?
|
Schizophrenia is thought to be caused by excessive dopaminergic activity.
|
|
|
Describe the symptoms of the Extrapyramidal side effects of Classic antipsychotic drugs (due to dopaminergic blockade). How do you treat these symptoms?
|
Dystonia, Parkinson-like symptoms and Akathesias due to Dopaminergic blockade of the nigro-striatal pathway. These symptoms can be treated by sedative antihistamines w/anticholinergic actions (e.g. diphenhydramine a.k.a. Benedryl).
|
|
|
What is the symptom of Tardive dyskinesia associated with the adverse effects of antipsychotic drugs due to?
|
Tardive dyskinesias are due to the super sensitivity of dopamine receptors. This is a late-occuring syndrome of abnormal choreoathetoid movements.
|
|
|
Describe the endocrine effects that are associated with the adverse effects of antipsychotic drugs.
|
Endocrine effects such as amenorrhea-galactorrhea, infertility, and impotence are associated with the use of antipsychotic drugs due to dopamine receptor blockade leading to hyperprolactinemia.
|
|
|
Why do sedation and confusion occur with the use of antipsychotic drugs?
|
Sedation and confusion can occur with the use of antipsychotic drugs due to the effects of muscarinic blockade at the CNS.
|
|
|
What is Neuroleptic malignant syndrome? What types of medications is it associated with?
|
Neuroleptic malignant syndrome is a rare, but life-threatening disease. It is a state of altered consciousness with markedly enhanced muscle tones and the potential for renal failure.
|
|
|
Why are Atypical Antipsychotic drugs now preferred for use to Classic/Typical Antipsychotic drugs? What side effect is shared between both classes of medication?
|
This is because the Atypical Antipsychotic drug side effect profile and therapeutic ratio is much better. There is the absence or minimal appearance of the dopaminergic side effects (i.e. EPS, TD and endocrine dysfunction). Weight gain is a problem of both conventional and atypical antipsychotic drugs.
|
|
|
What are the most important disadvantages of taking Chlorpromazine?
|
Many, including autonomic side effects.
|
|
|
What are the most important disadvantages of taking Haloperidol?
|
Severe Extrapyramidal Syndrome.
|
|
|
What are the most important disadvantages of taking Clozapine?
|
Causes agranulocytosis in up to 2% of patients.
|
|
|
What are the most important disadvantages of taking Risperidone?
|
Extrapyramidal syndrome, but only at higher doses.
|
|
|
What are the most important disadvantages of taking Olanzepine?
|
Weight gain.
|
|
|
What are the two antipsychotic drugs that are most commonly used for Post-parrtum psychosis?
|
Olanzepine and risperidone.
|
|
|
Olanzepine and Risperidone have largely replaced the more traditional use of what two antipsychotic medications?
|
Chlorpromazine and Imipramine.
|
|
|
Provide a list of 7 indications for which antipsychotic drugs can be used.
|
Schizophrenia, Post-partum psychosis, Manic episodes and Bipolar Affective Disorder, Tourette's syndrome, Antiemetics, Neurolept anesthesia, and Hyperkinetic movement disorders.
|
|
|
Explain the mechanism of action that allows some of the older antipsychotic drugs to be used as Antiemetics.
|
Most of the older antipsychotic drugs can be used for their strong antiemetic effect due to DA receptor blockade at the chemoreceptor trigger zone.
|
|
|
Which drug produces the highest level of EPS or extrapyramidal symptoms of coventional or atypical antipsychotics?
|
Haloperidol produces the highest level of EPS or extrapyramidal symptoms of coventional or atypical antipsychotics; tardive dyskinesia, torsade de pointes (prolonged QTc), orthostatic hypotension, galactorrhea, amenorrhea
|
|
|
What is the most common form of depression and what percentage of all depression does it account for?
|
The most common form of depression is Reactive or secondary depression at 60%.
|
|
|
What percentage of all depression does Major Depressive Disorder account for?
|
~25%.
|
|
|
Provide a short list of TCA side effects.
|
Antimuscarinic, antihistamine, alpha receptor blockade, Na channel block/QRS widening, elevated catecholamines, Cardiac Ikr block (QT prolongation).
|
|
|
What are the two prototypical Tricyclic Antidepressants?
|
Imipramine and Amitryptyline.
|
|
|
What are the four prototypical Selective Serotonin Reuptake Inhibitors (SSRIs)?
|
Fluoxetine, Citalopram, Paroxetine, and Sertraline.
|
|
|
Compare and contrast SSRIs to TCAs.
|
To summarize, the efficacy of SSRIs is similar to the TCAs, however they have far fewer side effects due to their more specific mechanism of action.
|
|
|
In addition to being a first-line agent against depression, what are some other disorders that SSRIs are used for?
|
Obsessive compulsive disorder, bulimia, and social phobia.
|
|
|
What are the "therapeutically irrelevant" actions of the Tricyclic antidepressants?
|
The effects of Tricyclic antidepressants to block histamine, muscarinic, and in some cases, adrenergic receptors are therapeutically irrelevant.
|
|
|
What are the four prototypical Atypical Antidepressants?
|
Bupropion, Venalfaxine, Duloxetine, and Nefazodone (recently withdrawn)
|
|
|
Venfalaxine is one example of the newer designer antidepressants that targets more than one NT. What is the class name that these type drugs are most commonly called?
|
SNRIs (Serotonin & Norepinephrine Reuptake Inhibitors), although most tend to have additional actions as well (which may or may not contribute to their therapeutic actions).
|
|
|
Some SNRIs have been found to be helpful at treating what other problems that are found to affect people with depression?
|
Insomnia, chronic pain (fibromyalgia), or smoking cessation.
|
|
|
Venfalaxine an SNRI has a more rapid onset of action when compared to Fluoxetine an SSRI, but it does share an important side effect with Fluoxetine. What is it?
|
Impairment of sexual function.
|
|
|
Bupropion is a weak inhibitor of serotonin and norepinephrine & dopamine reuptake, but what indication has it been reported as useful for? What is Bupropion absolutely contraindicated for?
|
Bupropion has been reported to be useful for treating patients who are trying to break their addiction to smoking cigarettes. It is contraindicated in patients suffering from seizure disorders because its stimulant properties can increase the incidence of seizures in such patients.
|
|
|
What type of medication is Nefazodone and why was it recently withdrawn from the market?
|
Nefazodone is an Atypical antipsychotic drug that was recently withdrawn from the market due to concerns about its rare, but fatal liver toxicity.
|
|
|
Which recently introduced SNRI is the most selective inhibitor of the reuptake of both serotonin and norepinephrine reuptake, with few, if any, other actions?
|
Duloxetine (Cymbalta)
|
|
|
What are the "therapeutically irrelevant" actions of the Tricyclic antidepressants?
|
The effects of Tricyclic antidepressants to block histamine, muscarinic, and in some cases, adrenergic receptors are therapeutically irrelevant.
|
|
|
What are the four prototypical Atypical Antidepressants?
|
Bupropion, Venalfaxine, Duloxetine, and Nefazodone (recently withdrawn)
|
|
|
Venfalaxine is one example of the newer designer antidepressants that targets more than one NT. What is the class name that these type drugs are most commonly called?
|
SNRIs (Serotonin & Norepinephrine Reuptake Inhibitors), although most tend to have additional actions as well (which may or may not contribute to their therapeutic actions).
|
|
|
Some SNRIs have been found to be helpful at treating what other problems that are found to affect people with depression?
|
Insomnia, chronic pain (fibromyalgia), or smoking cessation.
|
|
|
Venfalaxine an SNRI has a more rapid onset of action when compared to Fluoxetine an SSRI, but it does share an important side effect with Fluoxetine. What is it?
|
Impairment of sexual function.
|
|
|
Bupropion is a weak inhibitor of serotonin and norepinephrine & dopamine reuptake, but what indication has it been reported as useful for? What is Bupropion absolutely contraindicated for?
|
Bupropion has been reported to be useful for treating patients who are trying to break their addiction to smoking cigarettes. It is contraindicated in patients suffering from seizure disorders because its stimulant properties can increase the incidence of seizures in such patients.
|
|
|
What type of medication is Nefazodone and why was it recently withdrawn from the market?
|
Nefazodone is an Atypical antipsychotic drug that was recently withdrawn from the market due to concerns about its rare, but fatal liver toxicity.
|
|
|
Which recently introduced SNRI is the most selective inhibitor of the reuptake of both serotonin and norepinephrine reuptake, with few, if any, other actions?
|
Duloxetine (Cymbalta)
|
|
|
With what organelle is MAO associated with inside the cell?
|
MAO is located intracellularly and is associated with mitochondria.
|
|
|
What is the main job of MAO in the CNS and peripheral tissues? What is the crucial defensive role that it plays in the liver?
|
MAO regulates the metabolic degradation of catecholamines and serotonin in the CNS and peripheral tissue. Hepatic MAO plays a crucial defensive role in inactivating ingested monoamines (e.g. Tyramine), or those that are present in the circulation.
|
|
|
What are the two subtypes of MAO? Where is each found and which substrates does each act on?
|
MAO exists in two isoforms: MAO-A, and MAO-B. MAO-A is the primary form found in serotonin (5-HT) and norepinephrine nerve terminals and in the human gut. It has substrate preference for 5-HT, Norepi, and Tyramine. MAO-B is found in the nigrostriatal (dopaminergic) neurons in the CNS and blood platelets, and substrate specificity for dopamine.
|
|
|
What are the most commonly used MAO inhibitors used in the U.S.? Are they selective? How do they act on MAO?
|
The most commonly used MAO inhibitors include Phenlzine, Selegiline, and Tranycypromine. These drugs are irreversible and non-selective for MAO-A and B.
|
|
|
What is Selegiline? Describe what condition it is most commonly used for outside of treating depression and why.
|
Selegiline is a non-selective MAO that has a preference for MAO-B at low levels. Because of this preference it stops the breakdown of Dopamine. This drug has been approved for the treatment of early Parkinsonism.
|
|
|
At doses that are effective for treating depression, does Selegiline have a preference for MOA-A or B?
|
Neither. At doses that are effective for treating depression Selegiline inhibits both MAO isoforms.
|
|
|
Why will the inhibition of MAO persist even after the MOAIs are eliminated from the body?
|
This occurs because MAOIs bind irreversibly to MAOs.
|
|
|
MAOIs also inhibit what other liver enzymes aside from hepatic MAO?
|
MAOIs are inhibitors of cytP450 and can cause many drug interactions.
|
|
|
Irreversible block of MAO results in the loss of what type of effect from the liver on what types of compounds?
|
Irreversible block of MAO results in a loss of the first pass metabolism in the liver that protects the body from Tyramine and other amines found in many fermented foods (e.g. red-wine, home-brewed beer, aged cheese) and some natural herbs (ephedra).
|
|
|
St. John's Wort is a known inducer of what two chemical metabolic pathways in the liver?
|
cyt-P450 and P-glycoprotein.
|
|
|
With what organelle is MAO associated with inside the cell?
|
MAO is located intracellularly and is associated with mitochondria.
|
|
|
What is the main job of MAO in the CNS and peripheral tissues? What is the crucial defensive role that it plays in the liver?
|
MAO regulates the metabolic degradation of catecholamines and serotonin in the CNS and peripheral tissue. Hepatic MAO plays a crucial defensive role in inactivating ingested monoamines (e.g. Tyramine), or those that are present in the circulation.
|
|
|
What are the two subtypes of MAO? Where is each found and which substrates does each act on?
|
MAO exists in two isoforms: MAO-A, and MAO-B. MAO-A is the primary form found in serotonin (5-HT) and norepinephrine nerve terminals and in the human gut. It has substrate preference for 5-HT, Norepi, and Tyramine. MAO-B is found in the nigrostriatal (dopaminergic) neurons in the CNS and blood platelets, and substrate specificity for dopamine.
|
|
|
What are the most commonly used MAO inhibitors used in the U.S.? Are they selective? How do they act on MAO?
|
The most commonly used MAO inhibitors include Phenlzine, Selegiline, and Tranycypromine. These drugs are irreversible and non-selective for MAO-A and B.
|
|
|
What is Selegiline? Describe what condition it is most commonly used for outside of treating depression and why.
|
Selegiline is a non-selective MAO that has a preference for MAO-B at low levels. Because of this preference it stops the breakdown of Dopamine. This drug has been approved for the treatment of early Parkinsonism.
|
|
|
At doses that are effective for treating depression, does Selegiline have a preference for MOA-A or B?
|
Neither. At doses that are effective for treating depression Selegiline inhibits both MAO isoforms.
|
|
|
Why will the inhibition of MAO persist even after the MOAIs are eliminated from the body?
|
This occurs because MAOIs bind irreversibly to MAOs.
|
|
|
MAOIs also inhibit what other liver enzymes aside from hepatic MAO?
|
MAOIs are inhibitors of cytP450 and can cause many drug interactions.
|
|
|
Irreversible block of MAO results in the loss of what type of effect from the liver on what types of compounds?
|
Irreversible block of MAO results in a loss of the first pass metabolism in the liver that protects the body from Tyramine and other amines found in many fermented foods (e.g. red-wine, home-brewed beer, aged cheese) and some natural herbs (ephedra).
|
|
|
St. John's Wort is a known inducer of what two chemical metabolic pathways in the liver?
|
cyt-P450 and P-glycoprotein.
|
|
|
Describe the most recent recommendations for treating someone with acute major depression. Explain the logic behind them.
|
It is recommended that patients with acute major depression be treated with SSRIs or Atypical Antidepressants as compared to TCAs or MAOIs. This recommendation is based upon fewer adverse side effects, reasonable cost, and patient preferences.
|
|
|
What is the most effective medication against Atypical Depression?
|
MAOIs.
|
|
|
What are the specific side effects of SSRIs that are of most concern to patients?
|
Transient nausea, sexual dysfunction, and decreased libido.
|
|
|
What are the specific side effects of TCAs that are of most concern?
|
Orthostatic hypotension, dry mouth, and prolonged QRS. Tricyclics are extremely dangerous when taken in overdose quantities and can cause a wide variety of symptoms including cardiac arrhythmias, and seizures.
|
|
|
Which SSRI has been shown to have teratogenic effects? What other side effect has this drug been shown to have in adults?
|
Paroxetine. This drug has also been shown to increase the incidence of suicidal behavior in adults treated for major depressive disorder.
|
|
|
What are the main drug interactions to consider that can produce Serotonin syndrome in pateints?
|
Serotonin syndrome can occur when an SSRI of SNRI is used in the presence of and MAO inhibitor or a Triptan. The combination of increased stores of serotonin after taking an MAOI, or the presence of a serotonin agonist, with a serotonin reuptake inhibitor can result in serotonin syndrome.
|
|
|
Describe the symptoms of Serotonin syndrome.
|
Hyperthermia, muscle rigidiity, sudden muscle jerks (myoclonus), rapid changes in mental status and vital signs, cardiovascular collapse.
|
|
|
What is Fluoxetine's active metabolite and how long is it necessary to wait before putting a patient on an MAOI after stopping the use of Fluoxetine? What syndrome are you trying to avoid precipitating?
|
Fluoxetine's active metabolite is Norfluoxetine and a 5 week washout period is necessary before starting and MAO inhibitor in order to avoid Serotonin syndrome.
|
|
|
What is Neuroleptic Malignant Syndrome? Describe the symptoms. What is it caused by and how would you go about treating it?
|
NMS is a rare, but potentially lethal side effect that can occur with typical antipsychotics, and much more rarely with atypical antipsychotics. The symptoms include severe muscle rigidity (typically the initial symptom), fever (often greater than 40C), autonomic changes (fluctuating blood pressure, pulse rate, tachypnea), altered consciousness (stupor that can progress to coma). It is treated with Dantrolene, Bromocriptine
Amantadine, Benzodiazepines (diazepam), or combinations of these agents. |
|
|
The typical antipsychotics have the wide range of side effects that they do because they block which varieties of neuronal receptors?
|
5-HT, Alpha-1, H1, Muscarinic.
|
|
|
What percentage of patients will develop some form or degree of EPS symptoms acutely after taking Typical Antipsychotics for an extended period of time?
|
~60%.
|
|
|
Describe some of the signs and symptoms of Tardive Dyskinesia. What type of antipsychosis medication is TD most commonly associated with? How long does it take for TD to develop?
|
The signs and symptoms of TD include facial grimacing, lip smacking, puckering, toe tapping, and a pill rolling tremor with the hands. ~20% of patients on chronic therapy with Typical Antipsychotics will develop TD, and this is less common for Atypicals. This takes YEARS to develop.
|
|
|
Describe the mechanism by which Tardive Dyskinesias are thought to be cause by Typical Antipsychotic drugs.
|
The causes for TD are poorly understood, but are thought to perhaps be the result of Dopamine Hypersensitivity or the imbalance of NTs in different pathways in the CNS.
|
|
|
Describe some of the broader symptoms that make up ExtraPyramidal Syndrome (EPS) associated with Typical Antipsychotic Therapy.
|
Acute dystonia, Parkinsonism, and Akathisia.
|
|
|
What are some of the endocrine side effects that are produced by the use of Atypical Antipsychotics? Describe the mechanism of these side effects.
|
Because Dopamine is a normal inhibitory regulator of prolactin secretion, as a result of the D2 antagonistic effects of the Typical Antipsychotics is to produce hyperprolactinemia and amenorrhea in women, and gynocomastia in men.
|
|
|
Which Atypical Antipsychotic drug is known for producing agranulocytosis and leukopenia? What type of precautions are necessary to take with someone who is taking this drug?
|
Clozapine is one of the atypical antipsychotics with the highest incidence of agranulocytosis, which occurs in 1-2% of patients. As a result, all patients started on Clozapine must undergo weekly CBC screening. This can be lowered to biweekly if the patients goes 6 months without symptoms.
|
|
|
Describe the autonomic side effects most commonly seen with Typical Antipsychotics.
|
The autonomic side effects include blurred vision, dry mouth, sedation, and urinary retention
|
|
|
Do Typical or Atypical antipsychotics have a greater effect on weight gain? Which two drugs have the greatest effect?
|
Atypicals have an association with greater weight gain than do Typical antipsychotics. Clozapine and Olanzapine are the two that are most associated.
|
|
|
Atypical antipsychotics are first-line drugs for treating what disorder?
|
Bipolar Affect Disorder.
|
|
|
Haloperidol blocks all kinds of receptors, but which is the mechanism by which it is thought to exert its therapeutic effects?
|
D2 blockade.
|
|
|
How long can it take before the full effects of SSRIs are realized?
|
8--12 weeks.
|
|
|
Which medication can be added to a patient's therapy regimen in order to help reverse the side effect of sexual dysfunction associated with SSRIs?
|
Bupropion (Wellbutrin)
|
|
|
What are two of the main symptoms of atypical depression? Which medication is used as a first-line drug in treatment of atypical depression?
|
Two of the more characteristic features of Atypical Depression include increased sleeping and eating. There may also be a "phobic" anxiety aspect to their illness as well. One of the first-line drugs used in treating Atypical Depression is Phenelzine (MAO inhibitors).
|
|
|
What type of medications can precipitate a "switch" to bipolar disorder or "unmask" mania in a patient?
|
TCA's, SSRIs, SNRIs, and MAOIs can all do this when they are given to a patient who is misdiagnosed as having depression instead of the real diagnosis, which should be Bipolar Affect Disorder.
|
|
|
What are the median ages for the onset Bipolar Affect Disorder in men and in women?
|
~25 years in men; ~35 years in women
|
|
|
Which drugs are considered drugs of first choice for treating BPAD?
|
Li, Valproate, and the atypical antipsychotics.
|
|
|
Fluoxetine (Prozac) has an active metabolite that remains in the patient's body for how many days after terminating use? What is the name of this metabolite? Why is it important to know this?
|
The metabolite is Norfluoxetine, and it can stay in the body for 7-15 days after one has terminated use of the medication. This is important to know because Fluoxetine and Norfluoxetine are potent inhibitors of the cyt P450 system, and can continue to inhibit even after treatment is stopped. This can affect the metabolism and plasma concentrations of other drugs that may be started abruptly after.
|
|
|
Why is it that Paroxetine and Venlafaxine can produce more severe withdrawal symptoms than other SSRIs?
|
This can occur because both of these drugs have a very short half-life and lack long-acting second metabolites. So when medication is stopped the drug and active compounds leave the body very quickly.
|
|
|
Describe the mechanism of action of Li. What is the indication for use of Li?
|
Lithium alters the Na+ transport in neuronal cells and inhibits the recycling of neuronal membrane phosphoinositides. Lithium is used to treat the manic phase of bipolar disorder.
|
|
|
What are some of the side effects of Lithium use?
|
Side effects of Lithium include Polyuria, Polydypsia (nephrogenic diabetes insipidus), diarrhea, nausea, weight gain, and ataxia. Effects of severe toxicity include seizures, coma, and cardiovascular collapse.
|
|
|
Which classes of drugs have similar effectiveness in treating major depression, but have more side effects than SSRIs and thus they are not drugs of first choice?
|
TCAs and MAOIs.
|
|
|
Why should patients with Parkinson's disease avoid the use of SSRIs?
|
Patient's with Parkinson's should avoid SSRIs because they can increase the risk for tremor and other symptoms of the disease.
|
|
|
What types of drugs may precipitate depression?
|
Accutane, alcohol, beta-blockers, prednisone, reserpine, as well as withdrawal from amphetamines and cocaine.
|
|
|
What classes of drugs are used in treating patients with BPAD that are unresponsive to Li treatment? Provide examples.
|
Antiepileptics (valproic acid, carbamazipine, lamotrigene) and antipsychotics (haloperidol, olanzapine, ziprasidone, aripiprazole, risperidone).
|
